Turning your HHA into a 'green one': How home health can help the environment

Going 'green' can save money, involves staff

Although patient care is the No. 1 priority for home care managers and staff, a growing number of health care employees are recognizing that their workday activities can affect more than a patient's health — they can affect the environment.

"Many of us recycle and conserve resources in our homes because it is easy to see how to do these things in our personal life, and it is harder to see how to carry this philosophy into our professional lives," says Gary Laustsen, PhD, APRN, BC, assistant professor of nursing at the Oregon Health and Science University in La Grande.

Home care programs provide a wide range of opportunities to decrease waste, conserve resources, and recycle, he says. "We can't solve all of the environmental problems of the world but we can start with small things and the effects add up to a bigger impact," he says.

Boulder Community Hospital in Boulder, CO, established a statement of environmental principles to guide the organization in efforts to minimize the negative impact that a health care facility has on the environment. "We recognize that the health of our community is affected by the health of our environment and we need to do our part to protect the environment," says Kai Abelkis, sustainability coordinator for the hospital. "Our home care agency follows the same principles, and employees are encouraged to identify ways to improve efforts to recycle or minimize use of resources," he says.

Transportation has a great impact on the environment, and home care more than any other hospital department has employees in their cars all day long, Abelkis points out. "One home care employee has been encouraging other employees to purchase hybrid cars to reduce the amount of fuel needed for day-to-day work," he says. Purchasing a specific car is a significant commitment for any employee so this is not a change that will occur quickly, he admits.

"I am taking a look at what it would cost for the hospital to purchase cars for home care use compared to reimbursement for mileage," he says. "Another option that might be considered for all employees is an arrangement for a favorable-interest car loan for employees who purchase cars that get high mileage per gallon," he adds. Although both of these approaches are attractive, Abelkis points out that he is in the very early steps of evaluating their feasibility.

The first step a home care agency can make to reduce staff members' effect on the environment while making visits is to carefully plan visits to minimize each staff member's mileage to and between patient homes, suggests Abelkis. "Of course, this is something that most agencies do anyway to improve efficiency," he says.

He points out that choosing an environmentally friendly approach is often the most efficient or most cost-effective approach for many activities, besides being advantageous to the home care organization in many ways.

Coming up with out-of-the-box ideas, such as purchasing hybrid cars or partnering with a local bank for favorable car loans, is an important part of a successful environmental program, says Abelkis. In order to generate a good number of ideas, you need the involvement of everyone in the organization, he adds.

"Start with a commitment to an environmentally friendly value system and put your principles in writing," he says. Because the hospital board of directors and administrators support this effort, employees are enthusiastic in their own support, he adds. (To see a copy of the principles adopted by the Boulder Community Hospital board, go to www.bch.org, select "about BCH" and choose "environmental programs in the drop-down menu.")

Reduce waste before it arrives

Recycling aluminum cans and bottles in the break room and using blank sides of used paper for notepads are two ways staff in the home care office can reduce waste, says Abelkis. Another way is to work with the purchasing department and vendors to minimize packaging, he adds. Reducing waste is not only good for the environment but also good for the bottom line because the cost of waste removal is often based on weight, he points out. "The fewer pounds of waste to be removed from your health care facility, the lower the cost."

"The biggest culprit of inappropriate disposal of waste is red bag waste vs. regular trash," admits Laustsen. Not only can red bag trash be up to 10 times more expensive to dispose, but the incineration of items such as IV bags and tubing can release dioxin into the atmosphere if the incinerator's temperature is not high enough, Laustsen points out. "The less inappropriate trash that we put into the red bags, the less chance that dangerous chemicals will be released into the atmosphere," he adds.

While the idea of reducing waste may seem overwhelming, the first step is to conduct a waste assessment, suggests Laustsen. The assessment will give you a good idea of how your program is handling waste, what waste you generate, and how the waste disposal affects your program financially, he says. After the assessment, you can identify which areas you want to address first, he adds.

Environmentally preferred purchasing is one direction that many health care facilities are taking to reduce wasteful packaging as well as to reduce the type of toxins included in packaging and supplies, says Laustsen. "More vendors are offering environmentally safe options for supplies and more vendors are willing to alter packaging to reduce waste," he adds.

Finding ways to recycle materials is another way to reduce the amount of waste that must be disposed of by incineration or by burial in a landfill, says Laustsen. Some expired supplies or bandages that have been opened but unused and are clean but not sterile can be used by local veterinarians, he suggests. Boxes can be placed in a central area for employees to take home for use or clean plastic trays or containers used to package supplies can be used by local elementary schools for art classes.

In addition to donating items to local organizations, Abelkis also recommends donating medical supplies or equipment to organizations that distribute items to medical missions in other countries. "I collect items from all areas, including home care, and donate them to our local Project C.U.R.E.," he says

Dispose of drugs safely

Improper pharmaceutical disposal is another threat to the community, points out Abelkis. "There are not a lot of options for disposal of medications in the home," he admits. "We teach our home care patients to use glue or cat litter for disposal of medications," he says. By filling a prescription bottle of unused medications with glue or by emptying unused pills into soiled cat litter that is being thrown out, you can be sure that no one will be able to get the medication out of the trash, he says. This is preferable to flushing pills down the toilet, he adds.

Overall, health care employees are very receptive to opportunities to have a positive effect on the environment, says Laustsen. People are usually not resistant, just ignorant of the opportunities that exist, he says. "The key is to explore alternative ways to approach conservation and waste reduction, and to take baby steps as people get accustomed to the new approach."


For information about environmentally friendly policies, contact:

  • Gary Laustsen, PhD, APRN, BC, assistant professor of nursing, Oregon Health and Science University, La Grande, OR. Phone: (541) 962-3132. Fax: (541) 962-2727. E-mail: laustsen@ohsu.edu.
  • Kai Abelkis, sustainability coordinator, Boulder Community Foothills Hospital, Boulder, CO. Phone: (303) 440-2273. E-mail: kabelkis@bch.org.

For information about environmental policies, programs, and tools for health care, see:

  • Department of Environmental Services' New Hampshire Pollution Prevention Program has a section on their web site specific to home care. Information addresses disposal of pharmaceuticals and personal care items, reduction of mercury, recommendations for disposal of household-generated sharps, and environmentally preferred purchasing. Go to http://www.des.state.nh.us/nhppp/Healthcare_p2/index.asp.
  • Hospitals for a Healthy Environment (H2E). Web: www.h2e-online.org. This web site contains tools, resources, and information about waste reduction in health care. Information includes definitions of regulated medical waste and hazardous waste, and links to state regulations. A waste assessment tool can be found by going to the main page, selecting "waste reduction" from the top navigational bar, and scrolling down to "getting started."
  • Healthcare without Harm, www.noharm.org. Web site contains information on waste reduction, environmentally preferable purchasing, and design of a healthy building.
  • Web: www.cleanmed.org. This web site lists conferences that focus on waste reduction, environmentally preferable purchasing, and recycling. Free downloads of presentations and information from previous conferences are available on the web site.

The following organizations collect equipment and supplies for distribution to other countries in need of medical supplies: